Vietnam carries a substantial national burden of methicillin-resistant Staphylococcus aureus (MRSA), with MRSA representing approximately 73% of Staphylococcus aureus isolates. Neonatal-specific information—covering epidemiology, antimicrobial resistance profiles, treatment approaches, and prevention measures—is limited and scattered across regions and healthcare settings. This fragmentation complicates coordinated clinical responses in neonatal intensive care units (NICUs) and undermines consistent policy implementation.
Available national data indicate a dominant role for MRSA among S. aureus isolates, but the review emphasizes notable regional variation. Detailed neonatal epidemiology, including incidence, colonization versus infection rates, strain distribution, and temporal trends at the facility level, is incompletely reported. This heterogeneity in reporting and surveillance limits the ability to generalize findings across Vietnam and to develop uniformly effective NICU-level protocols.
Antibiotic overuse is widespread and a principal driver of resistance in Vietnam. The review reports that roughly 67.4% of hospitalized patients receive antibiotics, and as many as 90% of pediatric prescriptions may be inappropriate. Such patterns of empiric and often unnecessary antibiotic exposure amplify selective pressure favoring MRSA and other resistant organisms. The review links these prescribing behaviors to the observed high prevalence of MRSA and to the escalating threat posed by resistance among other pathogens.
For severe MRSA infections in neonates, vancomycin is identified as the first-line therapy. Alternative agents named in the review include linezolid, daptomycin, ceftaroline, clindamycin, and adjunctive rifampin; however, their roles in neonates are limited. The authors stress that alternatives should be considered only when supported by clinical context and local susceptibility data. Given variability in activity and safety profiles, the review underscores reliance on local antibiograms to inform agent selection rather than routine substitution for vancomycin.
Because vancomycin remains the cornerstone of therapy, the review highlights the importance of optimization to balance efficacy against toxicity. Key elements include AUC-guided dosing, therapeutic drug monitoring (TDM), and timely de-escalation when appropriate. These strategies aim to achieve therapeutic exposure while reducing nephrotoxicity and the selection pressure that may foster emergence of less-susceptible organisms. The review also warns that the emergence and spread of vancomycin-resistant organisms—including vancomycin-resistant enterococci reported in some settings up to 34%—poses a threat to the sustainability of last-line treatments.
The review identifies multiple interventions proven or hypothesized to reduce MRSA burden in NICUs. Recommended approaches include infection prevention bundles tailored to neonatal care, active surveillance cultures to detect colonization, and targeted decolonization for recognized carriers. Implementation of these measures should be aligned with local capacity and resources. The authors stress that prevention strategies must be adapted to Vietnam’s healthcare settings rather than imported wholesale from disparate systems.
Implementation of antimicrobial stewardship programs (ASPs) is presented as a high priority to curb inappropriate prescribing and slow resistance development. Stewardship activities should focus on reducing unnecessary antibiotic exposure, promoting guideline-concordant treatment, and supporting rapid de-escalation. The review emphasizes the central role of local antibiograms in guiding empiric and directed therapy for neonatal MRSA, given regional variability in susceptibility and the limited applicability of alternative agents.
The review highlights persistent knowledge gaps: incomplete neonatal epidemiologic data, limited regionally representative resistance surveillance, and sparse outcome data for alternative therapeutic agents in neonates. The authors recommend prioritizing research that generates facility- and region-specific data, evaluates the effectiveness of prevention bundles in local contexts, and refines vancomycin dosing and monitoring strategies for neonates. Clinically, priorities include optimizing vancomycin use through AUC-guided dosing and TDM, establishing stewardship programs, expanding surveillance, and tailoring infection control measures to local capacities.
MRSA is highly prevalent among S. aureus isolates in Vietnam and presents a significant challenge in neonatal care. The review advocates a combined strategy of optimized vancomycin use, targeted prevention measures, and robust antimicrobial stewardship—each informed by local antibiograms and adapted to the realities of Vietnam’s healthcare settings. Because neonatal data remain limited and fragmented, the authors call for strengthened surveillance and research to support evidence-based policies and to protect the efficacy of remaining last-line agents.